A Look At The Myths And Facts Behind ADHD Medication And Pregnancy

ADHD Medication and Pregnancy

Physicians often struggle to counsel patients on the safety of their ADHD medication during pregnancy. In the absence of more research, doctors must weigh the advantages and risks of using medication during pregnancy.

A recent cohort study of the population monitored 898 babies born to mothers who were taking ADHD medications throughout their pregnancy (stimulants amphetamine, methylphenidate dexamphetamine, methylphenidate; and non-stimulants such modafinil, atomoxetine, clonidine) until they were diagnosed with a developmental disorder or died or left the country.

Risk/Benefit Discussion

CAP Smart Take

Physicians are concerned about the long-term consequences of drug exposure in utero, particularly to centrally stimulating medications such as those used to treat ADHD.  adhd and medication I Am Psychiatry  is essential that women receive adequate guidance from their physicians about the potential risks and benefits of using medication during pregnancy and prior to conception. In this CAP smart take, we look at the most current data in this area and how they can inform the clinical practice.

Animal studies and illicit drug research have suggested that stimulant medication passes to the fetus via the placenta, and could negatively affect fetal growth and development. There is however, a limited amount of information regarding the way that the fetus reacts to dosages of prescribed stimulant medication during pregnancy, and the majority of this data comes from single-arm studies that have not been sufficiently powered to detect possible significant connections.

The most recent study by Cohen and colleagues stands out from the rest, as it is the biggest and most meticulously controlled. The study included 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information on medication use was gathered by analyzing the redeemed medication. The researchers specifically excluded women who reported receiving SSRI drugs or clonidine as these drugs may interact with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors also adjusted their studies to take into account possible confounding factors and to take into account the timing of in utero exposure.

The results of this study and other small-scale trials suggest that the vast number of women who continue to take their stimulant medications prescribed to treat ADHD during pregnancy are not experiencing adverse effects on their foetuses. Therefore, it is likely that many women who are pregnant will continue to use their ADHD medication. It is important for doctors to carefully weigh the benefits and risks of these drugs prior to advising their pregnant patients to stop taking the medications. Regardless of which choice they make, it is vital that pregnant women suffering from ADHD educate their spouses or relatives, partners and employers about the choice they've made. It is because the symptoms of hyperactivity, inattention and impulsivity are likely to return if the mother ceases taking medication.

Pregnancy Tests

Preconception counseling should consist of an extensive management plan that includes both behavioral and medical treatment and ongoing monitoring throughout the perinatal period. The plan should include a discussion of the current treatment regimens, particularly during the first trimester, when dangers to the baby resulting from untreated ADHD are the highest. This should be a collaborative effort with obstetrics, psychiatry, and primary care.

The discussion of risk/benefit should also consider how a woman will plan to manage her symptoms of ADHD during pregnancy, including the impact on family functioning as well as what she might feel about a decision to stop psychostimulant therapy during the initial stages of pregnancy. This should be based on a thorough review of evidence available, including consideration of the individual patient's requirements and concerns.

The authors of a massive study that followed children exposed to ADHD medications while in utero concluded that "continuation psychostimulant use during the early stages of pregnancy was not associated with adverse birth outcomes and if anything, was associated with less stress among mothers." However the conclusion they reached is not without a few limitations. The study did consider other aspects, including the length of time that stimulant medication was used in addition to the dose and sociodemographics. There is no research conducted that is controlled and examines the safety of continuing use of psychostimulants in nursing mothers.

There is no clear evidence from a scientific study regarding the safety of ADHD medication during pregnancy. However, most doctors have a basic understanding of what research suggests and can apply the best practices in consultation to each patient's specific needs. For example, it is well-known that there is a higher incidence of cardiac malformations among infants born to mothers who take methylphenidate in the first trimester of pregnancy (Cooper et al., 2018), while it is also important to note that this finding was based on one small study that did not account for variations in the demographics of patients or the underlying psychiatric co-morbidity.

In a recent study, ADDitude readers said that they were more likely to quit their ADHD medication during early pregnancy than in previous. Women who stopped taking psychostimulants in the first trimester showed a clinically significant rise in depression symptoms. They also reported feeling less able to enjoy their pregnancy and described their family functioning as more difficult than those who continued or increased dosages of ADHD medications.

Work Functioning Test

The work functioning test is an essential part of the test as it will determine if a patient is able to carry out their tasks. The test is designed to determine functional limitations. It includes materials handling that is graded (lifting to various levels pushing and pulling) as well as positional tolerance tests (sitting or standing in a balancing position, walking or stooping, kneeling, crawling) along with other relevant specialized tests (hand manipulation). The evaluator will analyze the results and formulate an appropriate return to work conclusion. ROC curves can be used to determine the point of minimal classification (MIC) in the general ability to work and physical work ability and the work-functioning issues score.

The MIC is calculated using the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates the scores of the general and physical work ability and work-functioning issues based on an answering an anchor question to prevent changes in the measurement from affecting the overall average.

Driving Test

The gold standard for treating ADHD is psychostimulant medications. It reduces symptoms and improves functioning in other areas, such as driving safety. Insufficiency due to severe, untreated ADHD can have significant financial and psychosocial effects.

Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to improve symptoms and enhance functioning. These strategies can help women to tailor their schedules and utilize their coping abilities in ways that reduce their ADHD's impact on work and other areas.

All of these factors are important to consider when deciding whether or not to pursue psychostimulant therapy. As the most recent data available indicate, although there is some concern regarding the effects of pregnancy on outcomes after in-utero exposure to stimulant medications the risks are minimal and the outcomes are influenced by other treatments, maternal health treatment, maternal mental and physical health and the comorbidities. Bang Madsen K., Bliddal m., Skoglund cb., Larsson h., Munk-Olsen t., Hove Thomsen p., Bergink V. In-utero exposure to attention-deficit/hyperactivity medication and its effects on offspring.